How To Use CPT Code 99404

CPT 99404 refers to preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual for approximately 60 minutes. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99404.

1. What is CPT 99404?

CPT 99404 is a medical billing code used to describe preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual during a separate encounter from a preventive medicine visit. The purpose of this code is to document and bill for counseling services related to subjects appropriate for the patient’s age, family history, and areas of concern, with the goal of preventing problems from developing and reducing risky choices and behaviors. The duration of the session is approximately 60 minutes.

2. 99404 CPT code description

The official description of CPT code 99404 is: “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes.”

3. Procedure

The 99404 procedure involves the following steps:

1. The provider meets with the patient for approximately 60 minutes.
2. Lab findings from recently performed tests, typically ordered at a preventive visit, are discussed.
3. Clinical findings from the preventive visit are also reviewed.
4. Based on the findings, patient’s age, circumstances, and family history, the provider discusses with the patient how to prevent problems from developing and reduce risky choices and behaviors.
5. Topics covered may vary depending on the patient’s age and needs, such as healthy food choices for children, prevention of sexually transmitted diseases for teens, or heart disease prevention and exercise programs for adults.

4. Qualifying circumstances

Patients eligible to receive CPT code 99404 services include those who:

• Have recently undergone a preventive medicine visit and require counseling based on the findings of that visit.
• Are at risk for developing health problems due to their age, family history, or lifestyle choices.
• Require guidance on risk factor reduction and preventive measures tailored to their specific needs and circumstances.
• Can benefit from a 60-minute counseling session to address their concerns and develop a plan for prevention and risk reduction.

5. When to use CPT code 99404

It is appropriate to bill the 99404 CPT code when:

• The provider has conducted a separate preventive medicine visit and identified the need for counseling based on the findings of that visit.
• The patient requires a 60-minute counseling session to discuss preventive measures and risk factor reduction strategies.
• The counseling session is tailored to the patient’s age, family history, and areas of concern, with the goal of preventing problems from developing and reducing risky choices and behaviors.

6. Documentation requirements

To support a claim for CPT 99404, the following information needs to be documented:

• Date and duration of the counseling session.
• Details of the preventive medicine visit, including lab and clinical findings, that led to the need for counseling.
• Specific topics discussed during the counseling session, tailored to the patient’s age, family history, and areas of concern.
• Recommendations and strategies provided to the patient for prevention and risk factor reduction.
• Any follow-up appointments or referrals made as a result of the counseling session.

7. Billing guidelines

When billing for CPT code 99404, keep in mind the following guidelines and tips:

• Ensure that the counseling session is separate from the preventive medicine visit and is not billed as part of that visit.
• Verify that the duration of the counseling session is approximately 60 minutes. If the session is shorter or longer, consider using a different CPT code within the 99401-99404 range, based on the actual duration.
• Document the required information to support the claim, as outlined in the documentation requirements section.
• Review any payer-specific guidelines or requirements for billing CPT 99404 to ensure compliance and avoid claim denials.

8. Historical information

CPT 99404 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates to the code since its addition.

9. Similar codes to CPT 99404

Five similar codes to CPT 99404 and how they differentiate are:

• CPT 99401: This code is used for preventive medicine counseling sessions lasting approximately 15 minutes.
• CPT 99402: This code is used for preventive medicine counseling sessions lasting approximately 30 minutes.
• CPT 99403: This code is used for preventive medicine counseling sessions lasting approximately 45 minutes.
• CPT 99411: This code is used for group preventive medicine counseling sessions lasting approximately 30 minutes.
• CPT 99412: This code is used for group preventive medicine counseling sessions lasting approximately 60 minutes.

10. Examples

Here are 10 detailed examples of CPT code 99404 procedures:

1. A 45-year-old patient with a family history of heart disease receives a 60-minute counseling session on heart-healthy nutrition, exercise, and stress management.
2. A teenager with a recent diagnosis of type 2 diabetes receives a 60-minute counseling session on managing blood sugar levels, healthy eating, and physical activity.
3. A 30-year-old patient with high blood pressure receives a 60-minute counseling session on lifestyle changes, including diet, exercise, and stress reduction techniques.
4. A 50-year-old patient with a family history of colon cancer receives a 60-minute counseling session on cancer prevention, including screening recommendations and dietary changes.
5. A 25-year-old patient with a history of substance abuse receives a 60-minute counseling session on relapse prevention strategies and coping mechanisms.
6. A 60-year-old patient with osteoporosis receives a 60-minute counseling session on bone health, including nutrition, exercise, and fall prevention strategies.
7. A 35-year-old patient with a high-stress job receives a 60-minute counseling session on stress management techniques and work-life balance strategies.
8. A 40-year-old patient with a family history of breast cancer receives a 60-minute counseling session on breast cancer prevention, including screening recommendations and risk reduction strategies.
9. A 55-year-old patient with a history of smoking receives a 60-minute counseling session on smoking cessation strategies and lung health.
10. A 20-year-old patient with a history of anxiety receives a 60-minute counseling session on mental health management, including relaxation techniques and self-care strategies.